Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

227 Cards in this Set

  • Front
  • Back
1. Institutional care in the past caused what result in patients?
-Failed to improve
-Developed additional symptoms
-Social breakdown syndrome
-Extreme withdrawal, anger, and physical aggressiveness
-Loss of interest in personal appearance and functioning
2. What is Milieu therapy?
A humanistic approach to institutional treatment based on the belief that institutions can help patients recover by creating a climate that promotes self-respect, responsible behavior, and meaningful activity
3. What is a token economy program?
Behavioral program in which a person's desirable behaviors are reinforced systematically throughout the day by the warding of tokens that can be exchanged for goods or privileges
4. What type of reinforcement is in a token economy program?
Conditioning Principles
-positively reinforce socially acceptable behaviors
-no reinforcement for unsocial behavior
5. What are some limitations of token economies?
1. Studies are uncontrollable (bring whole ward in rather than randomly assign patients to groups)
2. Ethical/legal problems (right to food,storage, space/furniture, movement)
3. Truly effective? (change overt behavior w/o changing psychotic beliefs)
6. what are anti psychotic drugs?
Drugs that help correct grossly confused or distorted thinking

-block excessive activity of dopamine, particularly at D-2 receptors
-Produce maximum level improvement w/in first 6 months of treatment
7. What are "conventional" anti-psychotic drugs?
Ones developed throughout the 60's,70's, and 80's
-neuroleptic drugs
8. What are "atypical" anti-psychotic drugs?
New drugs
-"second generation"
9. What are neuroleptic drugs?
Conventional anti-psychotic drugs, so called b/c they often produce undesirable effects similar to the symptoms of neurological disorders
10. How effective are anti-psychotic drugs?
-Reduce positive symptoms more than negative ones (especially conventional ones)
-Men respond less readily to drugs than women and require higher doses b/c men tend to have more negative symptoms
11. What are extrapyramidal effects?
Unwanted movements, such as severe shaking, bizarre looking grimaces, twisting of the body, and extreme restlessness, sometimes produced by conventional anti-psychotic drugs
12. Describe Medication-Induced movement disorders?
1. Parkinsonian and related symptoms
2. Neuroleptic Malignant Syndrome
3. Tardive Dyskinesia
13. Describe Parkinsonian symptoms?
-Most common extrapyramidal effect due to reduction of dopamine activity in substantia nigra
-Muscle tremors/rigidity
14. What is dystonia?
Involuntary muscle contractions that produce bizarre movements of the face, neck, tongue, and back
15. What is akathisia?
Great restlessness, agitation, and discomfort in the limbs
16. What is the substania nigra?
A part of the brain that coordinates movement and posture
17. What is neuroleptic malignant syndrone?
A severe, potentially fatal reaction

-affects 1% of patients, particularly elderl
18. What are the symptoms of neuroleptic malignant syndrone?
1. Muscle Rigidity
3. Altered Consciousness
4. Improper functioning of autonomic nervous system
19. What is tardive dyskinesia?
Extrapyramidal effects that appear in some patients after they have taken conventional drugs for some extended period of time (one year)

*affects up to 20% taking drugs
20. What are the symptoms of tardive dyskensia?
Involuntary movements usually of mouth, lips, tongue, legs, or body
30. Why are new drugs called atypical?
Their biological operation differs from that of the conventional drugs since atypicals are received at fewer D-2 receptors and more at D-1, D-4, and serotonin receptors
31. What is the effectiveness of atypical drugs?
85% effective compared to 65% effective conventional drugs

Reduce both positive and negative symptoms
32. What are the side effects of the atypical drugs?
-Produce fewer extrapyramidal side effects (need high dose)
-Don't produce tardive dyskinesia
-Risk of agranulocytosis
33. What is agranulocytosis?
A life-threatening reduction in white blood cells

*Sometimes produced by the atypical anti-psychotic Clozapine
34. What are relative that display high levels of expressed emotion like?
Very critical, emotionally overinvolved, and hostile
35. What are the features of effective community care for treating schizophrenia?
1. Coordination of patient services (esp for mentally ill chemical abusers, MICA)
2. Avaible short-term hospitalization
3. Partial hospitalization
4. Supervised residencies (milieu philosophy)
5. Occupational training (sheltered workshop)
36. How has community treatment failed?
-40-60% of schizophrenics receive no treatment
-Poor coordination of services
-Shortage of services
37. What is a case manager?
A community therapist who offers a full range of services for people with schizophrenia or other severe disorders, including therapy, advice, medication, guidance, and protection of patients' rights
38. Why is there a shortage of services?
1. Lack of mental health professionals who wish to work w/ severely disturbed
2. Not in my backyard
3. Funding shortages (primary reason)
39. What are the consequences of inadequate community treatment?
1. 8% enter alternative care facility (nursing home)
2. 18% in privately run residences w/ untrained individuals
3. 31% in rundown occupancy hotel
4. Majority are homeless (1/3 of homeless have severe mental disorder)
41. What is a personality?
Enduring patterns of perceiving, relating to, and thinking about the environment and oneself
42. What are personality traits?
How we react in our own predictable and consistent ways
43. What is the five-factor model of personality?
1. Open to experience
2. Conscientious
3. Extroversion
4. Agreeable
5. Neuroticism
44. What does it mean to be open to experience?
Proactive seeking and appreciation of experience for its own sake

Toleration for and exploration of the unfamiliar
45. What does conscientiousness mean?
Individual's degree of organization

Contrasts dependable, fastidious people with those who are lackadaisical and sloppy
46. What does extroversion imply?
Frequency and intensity of interpersonal interaction, activity level, need for stimulation, and capacity for joy
47. What is meant by agreeableness?
Quality of one's interpersonal orientation along a continuum from compassion to antagonism in thoughts, feelings, and actions
48. What is meant by neuroticism?
Proneness to psychological distress, unrealistic ideas, excessive cravings or urges, and maladaptive coping responses
49. How does this five-factor model of personality relate to personality disorders?
Majority of personality disorders are characterized by high levels of neuroticism and low levels of agreeableness
50. What do people with schizoid, schizotypal, and avoidant personality portray low levels of?
Low levels of extroversion
51. What do persons suffering from histrionic and narcissistic personality disorders exhibit?
High levels of extroversion
52. What is a personality disorder?
A very rigid pattern of inner experience and outward behavior that differs from the expectations of one's culture and leads to dysfunctioning
53. What are three characteristics of personality disorders?
1. Longstanding

2. Inflexible

3. Maladaptive
54. What is required according to the DSM-IV?
1. Deviates from cultural expectations w/ at least two of the following areas affected
2. Pervasive and inflexible
3. Onset in adolescence or early adulthood and pattern is stable/enduring
4. Leads to distress or impairment
55. In what areas do personality disorders manifest in (at least 2)?
Impulsive Control
Interpersonal Functioning
56. What is comorbidity?
The occurrence of two or more disorders in the same person
57. What do people with personality disorders often also suffer from?
Acute Axis 1 disorder
58. What things must be ruled out or are differential diagnosis when it comes to diagnosing a personality disorder?
1. Another mental disorder
2. Medical condition
3. Substance abuse
59. What are the three clusters that the DSM-IV separates the 10 personality disorders into?
1. Odd or Eccentric

2. Dramatic,Emotional,Erratic

3. Anxious or Fearful
60. Which disorders are in the "odd or eccentric" cluster?

1. Paranoid

2. Schizoid

3. Schizotypal personality
61. What are schizophrenia spectrum disorders?
The odd/eccentric personality disorders that clinicians believe to be related to schizophrenia

-often these people qualify for an additional diagnosis of schizophrenia or have close relatives w/ schizophrenia
62. What are characteristics of paranoid personality disorders?

Six symptoms...
1. Pervasive distrust and suspiciousness of others
2. Shun close relationships
3. Trust own ideas and abilities excessively
4. View other's motives as malevolent
5. Critical of weakness/fault in others but unable to recognize own mistakes
6. Sensitive to criticism
63. Do people with paranoid personality disorder have delusional suspicions?
NO, suspicions are only inaccurate and/or inappropriate
64. What's treatment like for people w/ paranoid PD?
-Many view role of patient as inferior and distrust/rebel against therapist
-Therapy is limited and slow
-Drug therapy is of limited help
65. What is schizoid PD?
A PD characterized by persistent avoidance of social relationships and little expression of emotion

Also have no social anxiety
66. What are some characteristics of schizoid PD?
-Little interest in sex
-Indifferent to family
-Focus on self
-Unaffected by criticism or praise
67. What is the treatment for schizoid PD?
Social withdrawal prevents from entering therapy unless some other disorder makes treatment necessary

-emotionally distant form therapist
-don't seem to care about treatment
-make limited progress
68. What is schizotypal PD?
A PD characterized by extreme discomfort in close relationships, odd forms of thinking and perceiving, and behavioral eccentricities
69. What are some characteristics of schizotypal PD?
-Ideas of reference
-Bodily illusions
-Belief in special extrasensory abilities
-Belief in having magical control
-Difficulty keeping attention focused
-Conversation can be digressive and vague
70. What are ideas of reference?
Belief that unrelated events pertain to them in some important way
71. What are bodily illusions?
Sensing an external "force" or presence
72. How is schizotypal PD similiar to schizophrenia?
-Both have been linked to family conflicts and to psychological disorders in parents
-Linked schizotypal PD to some of the same biological factors found in schizophrenia
73. What are the biological factors of schizotypal PD that have been linked to schizophrenia?
-High activity of dopamine
-Enlarged brain ventricles
-Smaller temporal lobes
-Loss of gray matter)
74. What other disorders has schizotypal PD been linked to?
-Linked to mood disorders

-Relative of people w/ depression have a higher than usual rate of schizotypal PD and vice versa
75. What is the treatment for schizotypal PD?
Anti-psychotic drugs in low doses appear to help some people
76. Diagnostic Criteria: Paranoid Personality Disorder
1. Pervasive distrust & suspiciousness. 4 or more of:
– Suspects without sufficient basis that others are
exploiting, harming or deceiving them
– Preoccupied with unjustified doubts about loyalty or
trustworthiness of others
– Reluctant to confide in others because of unwarranted
– Reads hidden demeaning or threatening meanings…
– Persistently bears grudges
– Perceives threats to character or reputation that are not
evident to others or quick to react angrily, counterattack
– Recurrent suspiciousness with justification re fidelity of
spouse or partner
2. Not due to schizophrenia or other psychotic disorder
77. Diagnostic Criteria: Schizoid PD
Pervasive pattern of detachment & restricted range
of emotion. 4 or more of the following:
– Neither desires nor enjoys close relationships; prefers
solitary activities
– Little if any interest in sexual experience
– Pleasure in few if any activities
– Lacks close friends or confidents other than 1st degree
– Indifferent to praise or criticism
– Emotional coldness, detachment, or flattened affect
78. Diagnostic Criteria: Schizotypal Personality Disorder: DSM-IV features Social-interpersonal deficits + cognitive-perceptual distortions
5 of 9 symptoms needed to diagnose:
• Ideas of reference
• Odd beliefs or magical thinking
• Unusual perceptual experiences
• Odd thinking or speech
• Suspiciousness or paranoid ideation
• inappropriate or constricted affect
• Odd, eccentric, or peculiar behavior or appearance
• Lack of close friends or confidants
• Excessive social anxiety (associated with paranoid fears)
79. Which PD's are in the "dramatic" cluster?
1. Anti-social
2. Borderline
3. Histrionic
4. Narcissistic
80. What is anti-social PD?
A PD marked by a general pattern of disregard for and violation of other peoples' rights
81. What are people with anti-social PD sometimes called?
Sociopaths or psychopaths
82. What is necessary for diagnosis of anti-social PD?
Must be 18 years old
83. How is antisocial PD related to criminal behavior?

What are some pre-indicators?
Aside from substance abuse, this is the disorder most closely linked to adult criminal behavior

Usually display some pattern of misbehavior before 15
84. What are some characteristics of anti-social PD?

Five symptoms....
1. Lie
2. Careless w/ money and fail to pay debt
3. Irritable, aggressive, quick to fight
4. Reckless
5. Lack moral conscience
85. What is a psychopathy?

What is it characterized by?
Two things...
Mental disorder, especially when manifested by antisocial behavior

Social Deviance and Interpersonal/Emotional Traits (omitted in DSM)
86. What does social deviance include?
-Poor behavior controls
-Need for excitement
-Lack of responsibility
-Early behavior problems
-Adult anti-social PD
87. What is meant by interpersonal/emotional traits?
-Glib and superficial
-Egocentric and grandiose
-Lack of remorse or guilt
-Lack of empathy
-Deceitful and manipulative
-Shallow emotions
88. What are the risk factors for anti-social PD?

Six signs...
1. Anti-social PD in parents
2. Difficult temperament
3. Relative lack of social skills
4. Consequences of past experience in anti-social behavior
5. High thresholds for anxiety/fear
6. Difficulty anticipating negative consequences and shift attention
89. What are some statistics w/ anti-social PD?
-Four times more common in men
-White Americans receive dx more than African Americans
-Usually criminal behavior declines after age of 40
-Higher rates of alcoholism and substance abuse
-Children w/ conduct disorder and ADHD have higher risk of developing anti-social PD
90. How is anti-social PD explained?

What is treatment like?
Explained by genetics, stress in childhood, and modeling (imitation)

1/4 of people w/ disorder receive treatment, but treatment is usu ineffective
91. What is borderline PD?
A PD characterized by repeated instability in interpersonal relationships, self image, and mood and by impulsive behavior
92. Diagnostic Criters: Borderline Personality Disorder
-Features personal interpersonal instability and impulsivity
-5 of 9 symptoms needed to diagnose:
• Frantic efforts to avoid real or imagined abandonment
• Unstable and intense relationships
• Unstable self-image or sense of self
• Self-damaging impulsivity in at least 2 areas
• Recurrent suicidal or self-mutilating behavior
• Affective instability and reactivity
• Chronic feelings of emptiness
• Inappropriate, intense anger or difficulty controlling anger
• Transient, stress-related paranoid ideation or dissociation
93. What are some borderline PD statistics?
-20% of psychatric patients meet criteria
-3 to 5% of general population
-3/4 female
94. What are some characteristics of borderline PD?

six symptoms....
1. Emotions seem to always be in conflict w/ the world
2. Prone to bouts of anger
3. Impulsive, self-destructive
4. Self-injurious
5. Intense, conflict-ridden relationships
6. Dramatic shifts in identity
95. What percent of people w/ borderline PD commit suicide? How many succeed?
70% of people attempt

6 to 10% succeed
96. What challenges do therapists face when treating borderline PD?
1. Clingy dependence
2. Manipulativeness
3. Need of exclusive relationship
4. Issues w/ separation and/or abandonment
5. Extreme devaluation
6. Setting Boundaries
97. What are some etiological considerations for borderline PD?
-Early parent-infant relationship
-Parental neglect
-Parental sexual/physical abuse
-Family stressors (alcoholism, divorce)
98. What is histrionic PD?
A PD characterized by a pattern of excessive emotionality and attention seeking

*once called hysterical PD
99. What are some characteristics of histrionic PD?
1. "emotionally" charged
2. Lack sense of really are
3. Vain, self-centered, demanding
4. Unable to delay gratification
5. Overreact when something gets in their way for attentions
100. What is narcissistic PD?
A PD marked by a broad pattern of grandiosity, need for admiration, and lack of empathy
101. What are some characteristics of narcissistic PD?

Six things...
1. Expect constant admiration and attention
2. Exaggerate achievements and talents
3. Appear arrogant
4. Choosy about friends
5. Make good first impressions
6. 75% are men
102. According to the social learning perspective, how is narcissistic PD explained?
-Parents consistently overrate child's performance

-Parents create an unrealistically high self-image for the child by being too positive
103. How is treatment for narcissistic PD?
-One of the most difficult to treat

-Usually only get treatment due to some other disorder, most commonly depression
104. What are the PD's in the anxious cluster?

1. Avoidant PD

2. Dependent PD

3. Obsessive-compulsive PD
105. What is avoidant PD?
A PD characterized by consistent discomfort and restraint in social situations, overwhelming feelings of inadequacy, and extreme sensitivity to negative evaluation
106. What are some characteristics of avoidant PD?
1. Dread criticism
2. Feel unappealing or inferior
3. Exaggerate difficulties of new situation
4. Few or no close friends but yearn for intimate relationships
5. Feel depressed and lonely
107. How is avoidant PD similar to social phobias?
Both have fear of humiliation and low confidence

*key difference: people with social phobia fear social circumstance while PD fear close relationships
108. What are dependent PD?
A PD characterized by a pattern of clinging and obedience, fear of separation, and an ongoing need to be taken care of
109. How do dependent and avoidant PD differ in regard to relationships?
People w/ avoidant PD have problems initiating relationships

People w/ dependent PD have difficulty with separation from relationships
110. What other things are people with dependent PD at risk for? Why?
At risk for depression, anxiety, and eating disorders

Because they feel distressed, lonely, sad, and often dislike themselves
111. What is obsessive-compulsive PD?
A PD marked by such an intense focus on orderliness, perfectionism, and control that the individual loses flexibility, openness, and efficiency
112. What are characteristics of obsessive-compulsive PD?

Six things...
1. Fail to grasp point of activity b/c too focused on details/organization
2. Work is behind schedule
3. Set unreasonably high standards
4. Rigid and stubborn
5. Usually white, educated, married, and employed
6. Twice as likely in men
113. What is the "Big 5" theory of personality?
Basic structure of personality may consist of five "supertraits"

neuroticism, extroversion, openness to experience, agreeableness, and conscientiousness
104. What are some problems of validity with diagnosing personality disorders?

Four things...
1. Unclear boundaries with normality
2. Overlap among PD (lowers reliability too)
3. Overlap with Axis I categories
4. Impoverished knowledge base
105. What is the chance of relative having a PD if proband is diagnosed as Schizotypal?

(schizophrenia, mood disorder, no dx)
Schizophrenia: 6.9

Mood Disorder: 2.3

No DX: 1.4
106. What is the chance of relative having a PD if proband is diagnosed as Paranoid?
Schizophrenia: 1.4

Mood Disorder: 0.6

No DX: .4
107. What is the chance of relative having a PD if proband is diagnosed as Avoidant?
Schizophrenia: 2.1

Mood Disorder: 0.6

No DX: 0.2
108. What is a proband?
the first affected family member who seeks medical attention for a genetic disorder
109. Which AXIS 1 disorders are each of the "odd" PD's similar to?
Paranoid: Schizophrenia; Delusional Disorder

Schizoid: Schizophrenia

Schizotypal: Schizophrenia; Delusional Disorder
110. Which AXIS 1 disorders are each of the "dramatic" PD's similar to?
Antisocial: Conduct Disorder

Borderline: Mood Disorders

Histrionic: Somatoform Disorders; Mood Disorders

Narcissistic: Cyclothymic Disorder
111. Which AXIS I disorders are the "anxious/fearful" PD's similar to?
Avoidant: Social Phobia

Dependent: Separation-Anxiety Disorder; Dysthymic Disorder

Obsessive-Compulsive: Obsessive-compulsive anxiety disorder
112. What is an impulse-control disorder?
-Fail to resist impulse, drive, or temptation that is harmful

-Increasing tension proceeds act, followed by relief and possibly (not in all) guilt
113. What are some examples of impulse-control disorders?
Intermittent Explosive Disorder
Pathological Gambling
114. Which PD's are high for Neuroticism? Which PD is low for it
Schizotypal, Borderline, Narcissistic, Histrionic, Dependent, Avoidant, Obsessive

115. Which PD's are high for Extroversion? Which PD's are low for it?
Borderline, Narcissistic, Histrionic, & Dependent

Paranoid, Schizotypal, Schizoid, Avoidant, Obsessive
116. Which PD's are high for Openness to experiences? Which PD
117. Which PD's are low for openness?
118. Which PD's are high for Agreeableness?
119. Which PD's are low for Agreeableness?
120. Which PD's are high for Conscientiousness and which are low?
Narcissistic & Obsessive

Borderline, Histrionic, & Antisocial
121. What are the two categories of mood disorders? What are subcategories of each?
1. Unipolar
-Major Depression
2. Manic-Depressive
122. What are mood disorders?
Periods of time in which normal mood variation is replaced by prolonged depression or mania and associated symptoms
123. What is depression?
A low, sad state marked by significant levels of sadness, lack of energy, low self-worth, guilt, and related symptoms
124. What is unipolar depression?
Depression without a history of mania
125. What is the prevalence of unipolar depression? What is chance of recurrence?

What is the sex ratio for unipolar depression?
6% to 9% prevalence
50% recurrence

Sex Ratio
-in children 1:1
-in adolescents & adults: 2:1 female
126. How does unipolar depression vary with age?
It increases in adolescence

It spikes in women in their 35-45

It spikes in men in their 50'2
127. What are the five areas of functioning through which depressive symptoms span?
Emotional Symptoms
Motivational Symptoms
Behavioral Symptoms
Cognitive Symptoms
Physical Symptoms
128. What are the symptoms of unipolar depression?

1. Intense sadness, dejection, feelings of emptiness
2. Loss of motivation, paralysis of will
3. Markedly altered activity level
4. Negative view of self & future
5. Increased risk of suicide (50% of suicides assoc w/ depression)
129. What are the symptoms of unipolar depression?

6. Complaints about intelligence and memory
7. Perception of performance decreased
8. Physical complaints
9. Sleep problems
10. Loss of interest in sex
11. Change in appetite
130. What drug problem is often comorbid with depression?
-self medication with alcohol leads to increased rates of alcohol abuse
-33 to 59% of alcohol abusers become depressed
-increased family incidence of alcohol and depressive disorder
131. What is the criteria for diagnosing major depressive episode?
Period marked by at least five symptoms of depression lasting for two weeks or more
132. What are the symptoms of a major depressive episode?
1. Depressed mood, most of the day nearly every day
2. Markedly diminished interest in all activities
3. Significant weight loss
4. Insomnia/hypersomnia
5. Psychomotor agitation or retardation
6. Fatigue/loss of energy
7. Extreme feelings of worthlessness/guilt
8. Diminished ability to concentrate/think
9. Recurrent thoughts of death or suicide
133. What is major depressive disorder (MDD)?
A severe pattern of depression that is disabling and is not caused by such factors as drugs or a general medical condition
134. What is the criteria for diagnosing major depressive disorder?
Experience a major depressive episode without having any history of mania
135. What does it mean to categorize MDD as recurrent? seasonal? catatonic? postpartum? melancholic?
1. Recurrent if it has been preceded by previous episode
2. Seasonal, changes w/ seasons
3. Catatonic, marked by either immobility or excessive activity
4. Postpartum, w/in 4 wks of giving birth
5. Melancholic, almost totally unaffected by pleasurable events
136. What is dysthymic disorder?
A mood disorder that is similar to but longer-lasting and less disabling than a major depressive disorder
137. What are the symptoms of dysthymia?

Seven symptoms...
1. Chronically depressed, usually for years
2. Problems eating
3. Problems sleeping
4. Tiredness
5. Difficulty concentrating
6. Low opinion of oneself
7. Feelings of hopelessness
138. What is the DSM criteria for diagnosing dysthymic disorder?

Four things...
1. Depressed mood most of the day, more days than not
2. 2+ yr duration w/ symptoms not absent for more than 2 months
3. No hx of manic or hypomanic episode
4. Significant distress or impairment
139. What does "double depression" mean?
When dysthymic disorder leads to major depressive disorder, the sequence is called double depression
140. What is exogenous (reactive) depression?
Depression that follows clear-cut stressful events
141. What is endogenous depression?
Depression that seems to be a response to internal factors
142. What are family pedigree studies? What have they found for depression?
Family pedigree studies select people with unipolar depression as probands, examine their relatives, and see whether depression also afflicts other members

*20% of relatives are depressed
143. What is a proband?
A proband is the person who is the focus of a genetic study
144. What have twin studies revealed about depression?
MZ twins: 46% other twin would develop unipolar depression

DZ twins: 20% other twin wold develop unipolar depression
145. What is seasonal affective disorder?
Seasonal pattern that onsets in late fall and winter due to increase secretion of melatonin when nights grow longer and longer
146. What is an adjustment disorder?
Development of behavioral or emotional symptoms in response to an identifiable stressor within 3 months of occurence

*symptoms are clinically significant
147. What must be ruled out before diagnosing adjustment disorder?
Not bereavement or another Axis I disorder
148. What is acute adjustment disorder?

What is chronic adjustment disorder?
Acute: limit of 6 months

Chronic: greater than 6 months
149. What are some risks for depression?

1. Marital status (separated or divorced 6.3%)
2. Sex of person (female)
3. Pile-up of stressful life events in a short time
4. Family hx of depression
5. Young kid w/ depressed parent
6. Lose parent prior to age 11
150. What are some risks for depression?
7. Poor social skills
8. Neuroticism
9. Negative schemas
10. Prior episodes (with repeated episodes, "triggers" become less important)
151. Low activity of what two neurotransmitters have been linked to unipolar depression?
norepinephrine (catecholamine) and serotonin (indolamine)
152. In depressed people, what gene has been seen to have abnormalities? What does this gene do?
Abnormality of 5-HTT gene

Gene is responsible for the brain's transportation of serotonin
153. Where are the cell bodies of norepinephrine and serotonin located?

Where do their axons extend to?
Norepinephrine: locus coerulus and lateral tegmental aread

Serotonin: raphe nuclei

Axons extend to limibic system and areas involved in emotional control
154. Serotonin is believed to possibly be a neuromodulator, what is a neuromodulator?
A chemical whose primary function is to increase or decrease the activity of other key neurotransmitters
155. How is cortisol linked to unipolar depression?
People with unipolar depression have abnormal levels of cortisol (hormone released by adrenal gland during stress)
156. What is the psychodynamic view for the cause of depression?
Series of unconscious processes is set in motion when a loved on dies

Unable to accept the loss so mourners regress to the oral stage
157. What is a symbolic loss?
According to Freudian theory, the loss of a valued object which is unconsciously interpreted as the loss of a loved one (aka imagined loss)
158. According to behavioral perspective, what three factors lead to a vicious cycle that maintains depression?
1. Low rate of behavioral output
2. Deficiency in social skills
3. Person is not getting enough positive reinforcement from the environment
159. What are the two cognitive views on causes for depression?
1. Theory of negative thinking

2. Theory of learned helplessness
160. In the theory of negative thinking, what four things combine to produce unipolar depression?
1. Maladaptive thinking
2. Cognitive triad
3. Errors in thinking
4. Automatic thoughts
161. What are maladaptive attitudes?
Attitudes such as "If I fail others will feel repelled by me" that result from own experience, family relations, and judgments from people around
162. What is a cognitive triad?
The forms of negative thinking that lead to people feeling depressed. The triad consists of a negative view of one's experiences, oneself, and the future
163. When people make errors in thinking, there are five common types what are they?
1. Selective abstraction (beat self up over missing one question on an exam)
2. Magnification and minimization (magnify negative and minimize positive events)
3. Personalizaton (it rained b/c I took the day off)
4. Maladaptive attitudes
5. Overgeneralization (I don't know the answer so I'm stupid)
164. What are automatic thoughts?
Numerous unpleasant thoughts that help to cause or maintain depression, anxiety, or other forms of psychological dysfunction
165. How do automatic thoughts produce feedback?
The cognitive processes generate new symptoms which increase the 'evidence' of the depressed person's misery and failure
166. What is learned helplessness?
The perception, based on past experiences, that one has no control over one's reinforcement and that they themselves are responsible for this helpless state
167. What is the attribution helplessness theory?
When people view events as beyond their control, they ask themselves why this is so and attribute to either internal or external causes that may be global or stable
168. What attributions will cause a person to feel helpless to prevent future negative outcomes and possibly experience depression?
Attribute present lack of control to some internal cause that is both stable and global
169. What is dichotomous thinking?
Form of all or nothing thinking that depressed people may exhibit

For example believing any grade below an A is terrible
170. What is interpersonal psychotherapy?
A treatment for unipolar depression that is based on the belief that clarifying and changing one's interpersonal problems will help lead to recovery
171. What are interpersonal losses?
The loss of an important loved one causing a depressed person to experience a grief reaction
172. What is an interpersonal role transition?
Depressed people may experience interpersonal role transition brought about by major life changes such as divorce or birth of a child
173. What are interpersonal deficits?
Some depressed people display interpersonal deficits such as extreme shyness or social awkwardness which prevent them from having intimate relationship
174. What is electroconvulsive shock therapy?
A treatment of last resort for those with severe depression or those not responding to other treatments where an electrical current is sent through the brain causing a brain seizure or convulstions
175. What are convulsions?
severe body spasms from ECT
176. What is insulin coma therapy?
When large doses of insulin were given to patients suffering from psychosis to produce the desired effect of brain seizures (they were very dangerous and sometimes resulted in death)
177. What is the effectiveness of ECT?
60 to 70% improvement in severe cases of depression
178. What are MAO inhibitors?
Monoamine oxidase inhibitors are anti-depressant drugs that prevent the action of the enzyme monoamine oxidase which breaks down neuroepinephrine
179. People taking MAO inhibitors cannot eat food containing what chemical? Why?
Tyramine (in cheeses, bananas, certain wines)

They will experience a dangerous rise in blood pressure if eat it
180. What are the three classes of anti-depressant drugs?
1. MAO inhibitors

2. Tricyclics

3. Second-generation (SSRI)
181. What are tricyclic anti-depressants?
Drugs such as imipramine that have three rings in their molecular structure
182. What was the original purpose of imipramine? What did it actually do?
Originally hope to combat schizophrenia

Found out it relieved unipolar depression in many people
183. How long must tricyclics be taken before seeing improvement?

What happens if you stop taking them once you feel relief?
Take at least 10 days

If stop taking immediately, run a risk of relapsing within a year so continue taking drug for 5 or more months after feeling depressed free
184. How do tricyclics and most second-generation anti-depressant work?
The block the re-uptake of norepinephrine or serotonin thus increasing the activity of the neurotransmitter
185. Why does it take 10 days for tricyclics to work?
When ingested they may possibly slow down the activity of the neurons that use norepinephrine and serotonin initially even though they immediately correct for the re-uptake mechanism
186. Which are given more MAO inhibitors or tricyclics? Why?
Tricyclics are prescribed more b/c there is no restriction on diet and usually people show higher rates of improvement when taking tricyclics
187. What are side effects of MAO inhibitors?

Four symptoms...
1. High blood pressure, stroke, death (due to tyramine ingestion)
2. Anti-cholinergic symptoms, less severe than with tricyclics
3. Weight gain
4. Overdose
188. What are possible side effects of tricyclics?

Three things....
1. Anti-cholinergic side effects
2. Weight gain
3. Overdose
*dizziness, confusion, delusions, hallucinations, rapid heart rate, seizures
189. What are anti-cholingeric side effects?

Four symptoms...
1. Dry mouth
2. Constipation
3. Urinary retention
4. Cardiac problems (orthostatic hypotension, ischemia)
190. What are the second-generation selective serotonin re-uptake inhibitors (SSRIs)
Anti-depressant drugs that increase serotonin activity specifically without affecting other neurotransmitters
191. What are examples of SSRIs?
Fluoxetine (Prozac)
Paroxetine (Prozac)
Sertraline (Zoloft)
192. What are the advantages of SSRIs?
1. Effectiveness and speed in on par with tricyclics
2. Harder to overdose on them
3. Don't pose dietary risks
4. Don't produce some of the unpleasant side effects (dry mouth and constipation) that tricyclics do
193. What are possible side effects of SSRIs

Seven symptoms...
1. Nausea
2. Loose bowel movements
3. Headache
4. Insomnia
5. Sexual dysfunction
6. Weight gain (rare)
7. Increase suicidal thoughts in adolescents
194. What are the most effective treatments for major depressive disorder?

Three treatments....
1. Cognitive or interpersonal psychotherapy (55%)
2. Anti-depressant drugs (65%)
3. ECT (60%)
195. What are the most effective treatments for dysthymic disorder?

Two treatments....
1. Cognitive or interpersonal psychotherapy

2. Anti-depressant drugs

*both about 60%
196. What is efficacy of behavioral in mild depression?

What is efficacy of placebo?

197. How does gender affect suicide attempt and "success"?
Twice as many women try it

Twice as many men "succeed"
198. What are some general facts about suicide?

Three things...
1. Few attempt w/o warning
2. 13 of 100,000 deaths in US
3. 15% of clinically depressed will commit suicide
199. What is a parasuicide?

How do parasuicider act? (Three things)
A suicide that does not result in death

-make sure of rescue
-used methods that are slow to work or completely ineffective
200. What is a death seeker?
A person who clearly intends to end his or her life at the time of suicide attempt
201. What is a death initiator?
A person who attempts suicide believing that the process of death is already under way and that he or she is simply quickening the process
202. What is anomic suicide?
Suicide committed by individuals whose social environment fails to provide stability thus leaving them w/o a sense of belonging
203. What is bipolar disorder?
A disorder marked by alternating or intermixed periods of mania and depression
204. What is mania?
A state or episode of euphoria or frenzied activity in which people may have an exaggerated belief that the world is theirs for the taking
205. What is a manic episode?
A period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week during which time at least 3 symptoms of mania
*episode may include delusions or hallucinations
206. What is a hypomanic episode?
When the symptoms of mania are less sever causing little impairment
207. What is characteristic of bipolar I disorder?
Have full manic and major depressive episodes causing significant distress
208. What are characteristics of bipolar I disorder?

six things...
1. Onset bwt 28-33 yrs
2. 1% prevalence
3. No difference in sex ration
4. First episode equally likely to be manic or depressive
5. Manic phase is 2-3 mo and depressive is 3+ mo
6. Course is recurrent (90% w/ multiple episodes)
209. What is bipolar II disorder?
Hypomanic episodes alternate with major depressive episodes (no manic episodes)
210. What is rapid cycling?
Experience four or more episodes of depression and mania or hypomania within a year and there is no intervening normal mood or intervening normal mood for max of 2 weeks
211. What are risk factors for rapid cycling? What gender is more prone to it?
Hypothryoidism is a risk factor

More common in women
212. What is schizoaffective disorder?
Uninterrupted period of illness that includes major depression or manic or mixed episodes w/ positive or negative symptoms of schizophrenia

Hallucination/delusions over 2 wks in asbence of depressed or manic mood and depressed or manic mood is present for much of active & residual period
213. What is cyclothymic disorder?
A disorder marked by numerous periods of hypomanic symptoms and mild depressive symptoms
214. What are three risk factors for recurrence of manic episodes?
1. Younger age at first manic episode
2. Lower stress level of event associated w/ first episode
3. Close family members who have any DSM-IV disorder
215. Which disorder(s) presents with similar characteristics to BPD?

What do they share?
Psychotic disorders (schizophrenia)

Common Symptoms:
1. delusions of grandiosity & persecution
2. Irritability
3. Agitation
4. Catatonic symptoms
216. What distinguishes psychotic disorders from BPD?
Those with psychotic disorders experience psychosis w/o mood symptoms
217. How do neurotransmitters relate to bipolar disorder?
Mania is associated with high norepinephrine levels and 5-HT is decreased in mania
218. What is the "permissive theory" of mood disorders?
Low 5-HT is a stage setter that is followed by high norepinephrine leading to mania followed by low norepinephrine leading to depression
219. What is the normal distribution of sodium ions in a cell at rest?
Na+ ions are on the outer side of the membrane until neuron is stimulated to open Na+ channels and let it in
220. How has Na+ been linked to bipolar disorder?
Persons with BPD have a Na+ dysfunction in that there is improper transport of Na+ between the outside and inside of the neuron's membrane
221. What have family studies revealed about bipolar disorder?
Average risk of 8% in 1st-degree relatives and bipolar probands' relatives are at increased risk (11%) for MDD
222. What drug is used to treat bipolar disorder?

What does this drug?

It reduces norepinephrine levels and thus its effectiveness is in treating mania
223. What is Lithium's mode of operation?
Lithium may affect 2nd messenger systems in certain neurons and in doing so may correct the neuron abnormalities from the previous neuron and the actual firing of the neuron
224. In short what three things does lithium possibly do?
1. Alter synaptic activity in neurons
2. Effect second messengers
3. Alter the activity of Na+ ions
225. What are second messengers?
Chemical changes within a neuron just after the neuron receives a neurotransmitter message and just before it responds (firing of neuron)
226. What is the effectiveness of Lithium?
Improvement rates of patient w/ bipolar range upward from 60%

Prophylatic effect: 40-60% avoid recurrence while taking lithium

Lithium also alleviates depressive episodes of bipolar disorder
227. How has melatonin been linked to depression?
The hormone is released in the dark and plays a role in seasonal affective disorder